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1.11 Peripheral Blood Smear
By Dr. Jetly
103
Pathology
Professional
01/11/2012

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Term
What stimulates leukopoeisis?
Definition
hormonally stimulated by 2 families of cytokines: interleukins and colony-stimulating factors
Term
What cells are the most important sources of cytokines?
Definition
Macrophages and T cells
Term
All leukocytes originate from ______.
Definition
pluripotent stem cell
Term
Common myeloid stem cell gives rise to what mature cells?
Definition
eosinophils, neutrophils, basophils, monocytes, erythrocytes, megakaryocytes/platelets
Term
What are the various sites of hematopoiesis throughout development?
Definition
3rd week= yolk sac; 3 months = liver (happens here until shortly after birth); 4 months = bone marrow
Term
What germ cell line are WBCs derived from?
Definition
mesoderm
Term
Where does hematopoiesis in adults occur?
Definition
bone marrow of central bones and peripheral joints
Term
Granulopoesis produces what mature cells?
Definition
PMNs, eo's, basophils
Term
Name the intermediates between myeloid stem cell and mature neutrophil.
Definition
myeloblast > promyelocyte > myelocyte > metamyelocyte > band
Term
What cell can give rise to any of the granulocytes?
Definition
myeloblast
Term
What are the intermediates between myeloid stem cell and mature RBC?
Definition
pronormoblast, basophilic normoblast, polychromatic normoblast, orthochromatic normoblast, polychromatic erythrocyte
Term
How long does it take for granulocytopoesis to create mature granulocytes?
Definition
14 days
Term
How long do granulocytes live?
Definition
1 day in circulation then 1-2 days in tissue
Term
How many granulocytes are produced by the bone marrow in a resting state?
Definition
1-2 X 10^9 granulocytes/kg/day
Term
How long does it take to produce RBCs?
Definition
7 days
Term
How long do red blood cells live?
Definition
120 days
Term
How many RBCs are produced by the resting bone marrow?
Definition
2-4 x 10^9/kg/day
Term
By how much can the bone marrow increase it's production of RBCs from its resting rate?
Definition
8x
Term
How long does it take for megakaryocytopoiesis?
Definition
10 days
Term
What happens during megakaryocytopoiesis?
Definition
endomitotic division 3-5 x
Term
How long do platelets live?
Definition
10 days
Term
What is the most reliable criterion of maturity?
Definition
nuclear chromatin coarsens and clumps
Term
What happens to the N/C ratio as maturation occurs?
Definition
decreases
Term
Name the three leukoblasts.
Definition
monoblast, myeloblast, and lymphoblast
Term
What are the characteristics of leukoblasts?
Definition
large cells, large nuclei, high N:C, fine chromatin, basophilic cytoplasm, no granules, and prominent nucleoli
Term
What diseases are associated with increased numbers of myeloblasts?
Definition
acute myelogenous leukemia, myeloproliferative states, erythroleukemia, rarely leukemoid reaction
Term
What's the difference between myeloblast and promyelocyte?
Definition
presence of dark azurophilic granules
Term
What are the conditions associated with increased numbers of promyelocytes?
Definition
acute myelogenous leukemia with maturation, acute promyelocytic leukemia, myeloproliferative disroders, rarely leukemoid reactions
Term
What're the morphological differences between a promyelocyte and a myelocyte?
Definition
slightly indented or flattened nucleus, no nucleoli, clumped chromatin, specific pink granules
Term
What conditions are associated with increased numbers of myelocytes?
Definition
myeloproliferative d/os, leukemoid reactions, AML with maturation, neutrophilic left shift, leukemoid reaction
Term
What is the last stage of granulopoesis where mitosis can occur?
Definition
myelocyte
Term
What're the morphological changes from a myelocyte to a metamyelocyte?
Definition
indented kidney shaped nucleus, numerous pink/specific granules
Term
What conditions are associated with increased numbers of metamyelocytes?
Definition
AML with maturation, myeloproliferative d/os, leukemoid reactions
Term
How can you differentiate leukoblasts?
Definition
ancillary studies; also, monoblasts generally have more cytoplasm
Term
What're the morphological changes as a cell goes from a metamyelocyte to a band cell?
Definition
indention becomes more than 1/2 the diameter of the theoretical round nucleus
Term
What conditions are associated with an increased number of band cells?
Definition
myeloproliferative d/os, neutrophilic left shift, and leukemoid reactions, also are normal constituents of peripheral blood
Term
How many lobes does a PMN have?
Definition
3 to 5
Term
Increased numbers of PMNs are associated with what conditions?
Definition
infections, stress, leukemoid reactions
Term
Where on a peripheral blood smear is the best place to look?
Definition
at the margin of the feathered edge where very few RBCs are overlapping
Term
What percent of total blood volume is made up of complete cells?
Definition
1%
Term
What is the deffinition of leukocytosis?
Definition
> 11,000 WBCs/mm3
Term
What percent of WBCs are PMNS?
Definition
50-65%
Term
What percent of WBCs are lymphocytes?
Definition
20-40%
Term
What percent of WBCs are bands?
Definition
0-5%
Term
What percent of white blood cells are eo's?
Definition
1-4%
Term
What percent of WBCs are monocytes?
Definition
4-8%
Term
What percent of WBCs are basophils?
Definition
0-1%
Term
What percent of lymphocytes are atypical?
Definition
<6%
Term
Granulocytes have cytoplasmic granules that stain specifically with ________ stain.
Definition
Wright's
Term
T/F Granulocytes are all phagocytic cells.
Definition
true
Term
What are the the neutrophilic granules?
Definition
perixodiases, hydrolytic enzymes, and defensins
Term
How big are PMNs vs bands?
Definition
10-15 um PMNs
10-18 um bands
Term
What role do eo's play in allergies?
Definition
lessen the severity by phagocytizing immune complexes
Term
What is the significance of a few dark purple granules in eosinophils?
Definition
probably a younger cell
Term
Eosinophils are increased in what conditions?
Definition
invasive parasites, drug reactions, allergic and skin d/os
Term
What cell can be confused with basophils?
Definition
neutrophils with toxic granules
Term
Increased numbers of basophils are seen in what conditions?
Definition
myeloproliferative states, hypersensitivity reactions, myxedema
Term
Describe the shape of the monocyte nucleus?
Definition
round to oval, often indented
Term
What conditions cause an increase in monocytes?
Definition
chronic infections, malignancy, inflammatory bowel disease, collagen vascular diseases
Term
How big is a lymphocyte versus a reactive lymphocyte?
Definition
lymphocyte= 8-10 um
reactive lymphocyte= 10-25 um
Term
Do lymphocytes have granules?
Definition
they have occasional azurophilic granules
Term
Lymphocytes are increased in what conditions?
Definition
chronic infections or inflamation; viral illness; drug reaction; acute infections (pertussis, mycoplasma, pneumonia, typhoid fever)
Term
What is a virocyte?
Definition
a reactive lymphocyte
Term
What is the morphology of a reactive lymphocyte?
Definition
variable round, oval, notched folded lobulated, indented or cleaved, may contain nucleoli, gray blue cytoplasm that may be darker peripherally, cytoplasm may contain fine azurophilic granules or vacuoles and be indented by adjacent red blood cells
Term
What conditions are associated with increased numbers of reactive lymphocytes?
Definition
can be normal, EBV, CMV, other viral, drug rxns, chronic inflammatory disorders (SLE or rheumatoid arthritis)
Term
How big are platelets?
Definition
1-5 um
Term
What are potential look alides of platelets?
Definition
extracellular babesia and stain precipitate
Term
Increased numbers of platelets occur in what conditions?
Definition
MPD, inflammation, exercise
Term
What size is normocytic for a RBC?
Definition
6-8 um in diameter
Term
What is a normochromic RBC?
Definition
RBC with central pallor approximately 1/3 the diameter of the cell
Term
What causes target cells?
Definition
excessive membrane (d/t excess lipid of liver disease) or less interior content (thalassemia or other hemoglobinopathies)
Term
What causes ovalocytes/elliptocytes?
Definition
hereditary elliptocytosis, megaloblastic anemia, thalessemia, severe iron deficiency anemia, sickle cell anemia, congenital dyserythrompoietic anemia
Term
What is a spherocyte?
Definition
spherical RBC, absent central pallor and usually decreased in diameter
Term
What causes spherocytes?
Definition
decreased membrane redundancy in conditions such as hereditary spherocytosis and immunohemolytic anemia
Term
What are stomatocytes?
Definition
mouth or cup=like deformity of RBCs
Term
What causes stomatocytes?
Definition
membrane defect d/t hereditary stomatocytosis and may see a few in immunohemolytic anemias
Term
What causes > 10% acanthocytes?
Definition
abetalipoproteinemia or advanced liver disease (alcoholism)
Term
What causes < 10% acathocytes?
Definition
post splenectomy, myeloproliferative disorders, autoimmune hemolytic anemia, sideroblastic anemia, thalassemia major, vitamin E deficiency
Term
What's the difference between an acanthocyte and an echinocyte?
Definition
acanthocyte has no central pallor and few big spurs
echinocyte has central pallor with numerous short blunt spicules
Term
What is the most common cause of echinocytes?
Definition
artifact of improper slide prep (slow drying, too thick, aged blood)
Term
What are diseases that cause echinocytes?
Definition
uremia or chronic renal disease, liver disease, myeloproliferative d/os, heparin therapy, post transfusion of aged blood
Term
Give synonyms for a fragmented cell.
Definition
schistocytes, helmet cell, keratocyte
Term
What conditions cause fragmented cells?
Definition
microangiopathic anemia, severe burns, DIC, thrombotic thrombocytopenic purpura, hemolytic uremia syndrome, malignant hypertension
Term
Do sickle cells have central pallor?
Definition
no
Term
Besides sickle cells, PBS of sickle cell patients also show..
Definition
ovalocytes, target cells, polychromias, basophilic stippling, NRBCs, H-J and pappenheimer bodies
Term
What causes hemoglobin C crystals?
Definition
hemoglobin C disease (HbCC) or Hemoglobin SC disease
Term
What is a howell-jolly body?
Definition
eccentrically placed fragment of DNA
Term
What are the conditions are associated with Howell-Jolly bodies?
Definition
hypo and asplenism, severe hemolytic anemia, megaloblastic anemia, congenital dyserythropoietic anemias
Term
What is basophilic stippling?
Definition
aggregated ribosomes and polyribosomes
Term
What conditions lead to basophilic stippling?
Definition
lead poisoning, thalessemia, refractory anemia, sideroblastic anemia, megaloblastic anemia, sickle cell anemia
Term
What are pappenheimer bodies composed of?
Definition
secondary lysosomes containing iron (non-heme) plus protein or iron-containing mitochondria
Term
What stain should you use to specifically see a pappenheimer body?
Definition
prussian blue (iron) stain
Term
What conditions are associated with pappenheimer bodies?
Definition
sideroblastic anemia, thalassemia, post-splenectomy states, congenital dyserythropoeitic anemias, hemolytic aenmieas, megaloblastic anemias
Term
Bite cells are characteristically due to a defect in ________.
Definition
a red blood cell enzyme. Precipitated hemoglobin is removed by spleen
Term
What do you call precipitated hemoglobin in a RBC?
Definition
heinz body
Term
What conditions are associated with bite cells?
Definition
disorders associated with Heinz body formation, unstable hemoglobins, chemical poisonings, oxidant drugs, G-6-PD deficiency and other enzymopathies
Term
What conditions are associated with NRBCs?
Definition
severe stress rxn, myelofibrosis (myelophthisic processes), thalessemias, hemolytic anemias, acute leukemia, myeloproliferative disorders, other severe anemias
Term
What are the morphological differences between a normal RBC and a polychromatophilic erythrocyte?
Definition
slightly larger, round to slightly oval, little or no central pallor, more basophilic (blue-gray cytoplasm)
Term
What special stain do you use for polychromatophilic erythrocytes?
Definition
supravital stain (new methylene blue, crystal violet) shows retained RNA (reticulocyte)
Term
What conditions are associtaed with polychromatiophilic erythrocytes?
Definition
newborns, after acute blood loss and recovery of marrow after cytoreduction (e.g. chemotherapy)
Term
What are associated conditions of rouleaux?
Definition
chronic liver disease with hypergammagloblulinemia, multiple myeloma, chronic infections and inflammatory processes, malignant lymphoma
Term
What is red cell agglutination?
Definition
irregular overlapping of red blood cells in a clump or cluster.
Term
What are associated conditions of red cell agglutination?
Definition
cold autoimmune hemolytic anemia, paroxysmal cold hemoglobinuria, cold agglutinins without anemia, malignant lymphomas associated with monoclonal IgM spikes (e.g. Waldenstrom's macroglobulinemia), plasma cell dyscrasia with monoclonal IgM paraprotein spikes
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